Of the estimated twenty-five million Americans who serve as caregivers to an elder, more than a quarter are doing it long distance – some of whom are doing it as far as a time-zone away.  This number is only expected to grow as more baby boomers take on the task of caring for their parents.  Caregivers and seniors are turning to all different options to secure the seniors safety while their caregivers are so distant.

Some seniors are choosing assisted-living facilities or continuing-care retirement communities (CCRCs) as opposed to nursing homes.  They offer residents meals, housekeeping and assistance with basic tasks, such as dressing and bathing.  CCRCs offer a wider range of living choices, allowing tenants to move from apartment to nursing facilities within the same complex.  The downside is that these facilities can cost up to several thousand dollars per month. For instance, a one-bedroom apartment, for entry fees alone can run as high as $8,000, with monthly rents of $1,000 and up. 

Another alternative is for the elders to stay in the comfort of their own home, which is an option being chosen more and more. The increase in seniors remaining in their homes has caused home-health-care services to boom. Nevertheless, one must be careful when picking such a service because they are not only expensive themselves, but it is more difficult to monitor the level of care. Although the number of certified home-care agencies has nearly doubled, there still remain many others with a lack of certification.  A recent federal audit concluded that 40% of home visits paid for by Medicare were unjustified. 

“”There’s a wide margin for fraud and abuse,” says Donna Wagner, author of the National Council on the Aging’s recent study “”Caring Across the Miles.”

The last option is turning to a Geriatric-Care-Manager (GCM), an on-site family proxy.  They arrange and oversee services ranging from shoveling the driveway, painting the house, caring for the senior. “[W]hatever needs to be done, we’ll do it.” says Mary Barringer, a GCM in Springfield, Ill.  Another worthwhile option, yet very pricey as well – with services ranging from around $50 – 100 an hour.

With all of these options, you must choose the one the best fits your needs. You must also pay close attention to these services’ certifications and reputations.  You need to trust the people who care for your loved ones, especially if you are not close by to monitor it yourself.   

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Bond was set at $500,000 Sunday for a West Side man accused of beating his nursing home roommate to death with a clock radio.

Fifty-year old Solomon Owasanoye was charged with first-degree murder on Saturday for the death of seventy-eight-year-old Ivory Jackson.  After being in a coma since May 30^th, Jackson sadly passed away June 23^rd at 9:04 in the morning at Advocate Christ Medical Center in Oak Lawn.  Jackson ultimately passed away due to “blunt head trauma from an assault, cranio-cerebral injuries and sepsis, and the death was ruled a homicide.” His attacker, Owasanoye who suffers from dementia, was his roommate. 

The All Faith Pavilion (formerly William L. Dawson Nursing Home) on Giles has a history of problems, including public health violations, according to a release from the Illinois Department of Public Health.  The Facility has currently paid at least $80,000 in fines since 2004 for “A” violations.  They have been cited for neglecting patients, failing to properly instruct staff and several other behaviors that resulted in the “substantial probability that death or serious mental or physical harm will result.”  Two deaths in the home were linked to neglect.

The first sign of trouble detected by the staff in this situation was after the fact.  Staff members initially saw Owasanoye sitting outside his room with blood on his shoes and hands.  Staff members then went into the room to find Jackson barely responsive and bleeding from his face and head.  A bloody clock radio was found on the floor next to Jackson’s bed.

How is it possible that no one on the staff had any idea this was taking place?  The patients at the facility need to be monitored much more closely to prevent incidents like this from happening in the future.

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Earlier this month, the Malden City Council voted unanimously to send legislators a home-rule-petition to make McFadden Memorial Manor, an aging city-run nursing home in Malden, MA, a geriatric authority not run by the city. If passed, McFadden Memorial Manor would no longer be managed by the city, under which the 61-bed facility has been losing about $500,000 annually for some time. The estimated forty McFadden residents have continuously called for improvements to the home – as it was built back in the 1880’s and needs more than one-million dollars in capital improvements. 

Charles Toomajian, special assistant to the mayor said, “Rather than close the place down, we are looking for alternatives for how to keep the place up and functioning,” Toomajian said. “A geriatric authority would go ahead and allow an independent body to run the facility, and it would be out of the city’s hands. . . . This seems to be the most viable option to maintain it as the facility it is today.”

Valerie Folk Melanson, a Friends of McFadden organizer whose brother lives at the nursing home, said residents and supporters are “cautiously optimistic” about the change. She said many had wanted McFadden to remain under the city’s province, but a geriatric authority was the next best outcome and better than being taken over by a private company that might not uphold the high level of care McFadden has been known to provide.

“It’s not a done deal, obviously, but at least we are still moving forward and the doors are still open,” she said.

Board members already have been chosen to run the geriatric authority. One of the board’s first tasks would be to figure out what improvements McFadden needs. The home, which has shared rooms and no private bathrooms, has long been unable to properly compete with more modern facilities and the large range of services they provide.

In order for the legislation to pass, it must make it through the House, Senate and needs the governor’s signature.

For more information click here. 

There are many questions that arise, when choosing a nursing home for yourself or a loved one. Care, location, and amenities are all examples. Moreover, one of the biggest questions is how one will be able to pay for nursing home care. Here are some important things one should know when dealing with the cost of nursing home care.

Although Medicaid will pick up as much as 100% of a resident’s nursing-home bill if necessary, those with income must effectively split the cost with the government. Nursing-home residents rarely work, but many have income from Social Security, pensions, annuities or other sources. Almost all of an individual’s income goes to the nursing home, except a “personal needs allowance” of $30 or so a month for extras like haircuts and toiletries. All income counts, including retirement and disability income.

The procedure is a bit different if the spouse of the resident does not live in a nursing home. The spouse is called a “community spouse” meaning he or she lives in the community rather than in a nursing home. They are entitled to the “Medicaid community spouse minimum monthly maintenance needs allowance,” which is a minimum of $1,750 a month (as of July 1) from your combined income. The amount the spouse outside the nursing home may keep varies due to a variety of factors. It is possible they may keep up to $2,610 as of July 1 and this figure can be even higher with a court order or a favorable ruling from a state administrative law judge.

Once the source of payment is settled, the best advice is to make sure to not fall behind on the payments. Nursing homes may evict residents, including Medicaid residents, who fall behind on their bills. Gene Coffey, a staff attorney for the National Senior Citizens Law Center says, “They can kick you out for nonpayment.” State officials say they routinely must intervene because family members fail to turn over money due to the nursing home. Also, financial abuse in which family members steal from nursing home residents is common. In this case, the state can appoint the nursing home or another guardian to receive the resident’s income on his or her behalf.

Also, financial obligations do not end at death. Federal law requires states to recoup some or all of what Medicaid spent from the estates of those who benefited under the program after turning 55. Nearly half of states put liens on nursing-home residents’ houses before they die, if they are deemed unlikely to return home, but all offer an appeals process. However, many postpone collection from widows and dependent or disabled children or exempt them entirely. States can also recover funds held in bank accounts, but many exempt joint accounts.

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The Robert Wood Johnson Foundation is investing fifteen-million dollars into a creative alternative to nursing homes. Green Houses aim to replace large nursing homes with small, homelike facilitates for ten to twelve residents. There are presently forty-one Green Houses in ten states; the goal is to have them in all fifty states.

Jane Lowe, from the foundation, states, “[w]e want to transform a broken system of care.” The goal of the Green Houses is to provide the seniors with a better quality of life and medical treatment. Unfortunately, many nursing homes are resisting these facilities due to the perceived costs associated with them. In reality, as the foundation studies the financial sustainability of the facilities, early indications show they are financially doable.

The Green Houses themselves are filled with residents that require nursing home care. The residents have private rooms and bathrooms, a residential-style kitchen, a communal dining area, and accessible outdoor space. The aspects of an institutional facility like medication carts, public address systems, and nurses’ stations are no where in sight. The overall feel is that of being home; even the dinning room table is big enough for all the residents and their families to eat together!

As far as overall quality of life is concerned - the residents reported: physical comfort, privacy, dignity, autonomy, ability to enjoy food, spiritual well-being, security, individuality, functional competence, relationships, and the ability to engage in meaningful activities. All of these are very positive results of living in these Green House facilities. I hope that more of these facilities continue to pop-up around the country.

For more information click here.

**Also for a 2 minute video on this topic click here.

Ramona Lamascola thought she was losing her eighty-eight-year-old mother, Theresa to dementia. Instead, she was losing her to overmedication.

Last fall, Theresa Lamascola was suffering from anxiety and confusion. She was then put on the antipsychotic drug Risperdal. When Theresa started having trouble walking, she was admitted to a nursing home facility, but her problems were just beginning. Ramona recalls, “[her] mother was screaming and out of it, drooling on herself and twitching.” The psychiatrist in the nursing home then stopped the Risperdal, which can cause twitching and vocal tics. He then prescribed a sedative and two other antipsychotic medications. Ramona was convinced that the medications were the problem, so she ordered the psychiatrist to “stop the medications and stay away from [her] Mom.”

It was not until Ramona Lamascola got a second opinion from another doctor who suggested stopping Theresa’s antipsychotic medications and sedatives and prescribed Aricept instead– which is a drug used for people suffering from mild to moderate dementia caused by Alzheimer’s disease. It improves the function of nerve cells in the brain which is important for memory. After being taken off the antipsychotic medications, Theresa’s quality of life improved. While she still has dementia, she went from confinement in a wheelchair - unable to sit still and screaming out in fear – to being able to walk with help, sit peacefully, have some memory and ability to communicate, and even make jokes. Ramona finally got her mother back!

There are other ways to help manage the behavior of a person suffering from dementia that does not include heavy medication and sedation. Some nursing homes are trying environmental intervention which consists of:

-Reducing boredom

-Providing intellectual and physical stimulation

-Exercise and calming music

-Bringing in pets for therapy and

-Improving how the staff approaches and talks to dementia patients

Unfortunately, research still shows that about a third off all nursing home patients have been given antipsychotic drugs without even trying these other methods. Why? The drugs are a quick fix as opposed to putting in a little extra time with the patients.

The Food and Drug Administration has ordered that the newer drugs carry a “black box” label warning of an increased risk of death. A similar precaution is now being taken with the older antipsychotic medications, as well.

Doctors are strongly encouraged to conduct a thorough assessment of the patient and only as a last resort turn to prescribing antipsychotic medication. If medications are necessary, a family member should communicate with the prescribing doctor, learn the goal of each medication, and be involved in making the decision. If still you’re not satisfied then seek out another doctor for another opinion.

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Nearly eight thousand seniors who fell and banged their heads died from brain injury in 2005. Another fifty-six-thousand had to be treated in hospitals for brain injuries sustained from a fall. “Most people think older adults may only break their hip when they fall, but our research shows that traumatic brain injuries can also be a serious consequence,” said Dr. Ileana Arias, director of the CDC’s National Center for Injury Prevention and Control. However, we are starting to see that the bigger issue is the damage being done to their brains – how they think and their ability to function.

Each year, one in three Americans over the age of sixty-five falls. Some suggestions for older adults, their caregivers, health care providers, and communities to help prevent these types of falls include:

-Reducing floor clutter

-Providing better lighting

-Regular exercise to maintain strength and balance

-Walking with a cane or walking aid of some kind when outside

These precautions will help to hopefully bring these statistics down and help keep our seniors safe.

For more information click here.

According to the National Center for Victims of Crime, a senior citizen is abused every 2.7 minutes.

When Debby Bitticks father became ill she took him in and became his caregiver, without giving it a second thought. Then shortly after, her mother-in-law passed away leaving her father-in-law all alone. The Bitticks hired someone to look after him at his home. When he began acting very different they decided to get to the bottom of it. They hired a private investigator who discovered her father-in-law was being abused. They were horrified and took him into their home immediately.

It is evident from this story that the elderly not only fall victim to abuse and neglect in nursing home facilities, but they also can fall victim in their very own homes. The Britticks suggest that when admitting a loved one to a nursing home, be sure the facility is a safe and healthy place. You can be sure by frequently visiting unannounced to see if the care is consistent with the impression they left with you in admitting your loved one. There are people who pretend to be caring when really they have ulterior motives. So to be sure you are placing your loved ones in a safe nursing home go through the necessary steps and precautions in order to be sure.

For more information click here.

As the number of violations at Tennessee nursing homes rise, two recent reports are targeting significant weaknesses in Tennessee’s oversight of health care facilities. An audit by the comptroller of the Treasury found a number of deficiencies in the Board for Licensing Health Care Facilities.

The audit found that the board failed to maintain a list of individuals, who have abused, neglected or misappropriated the property of vulnerable individuals. According to Art Hayes, director of state audit at the comptroller’s office, “That’s a very important function to have: a listing of anyone who is considered abusive and shouldn’t be working with vulnerable people. They’re not conducting all the investigations they should, they’re not holding the hearings timely and they’re not tracking people who are removed from the registry.” The audit also found that the licensing board failed to investigate complaints in a timely manner, which can keep nursing home patients in dangerous situations and make gathering evidence difficult.

The state performance audit was issued after the May report from the federal Government Accountability Office that listed Tennessee as one of nine states that most often neglected to cite serious violations at nursing homes during inspections between 2002 and 2007. The GAO found that Tennessee inspectors failed to record serious deficiencies 26.3 percent of the time. Walter Ochinko, assistant director for health care with the GAO said, “The results suggest some of the reasons for the understatement (of deficiencies) were inability to carry out an adequate investigation and determine what deficiencies should be cited.”

As consumers we expect that the government is capable of doing their job correctly. When faced with the decision of choosing a nursing home for ourselves or a loved one we rely on nursing home inspections to give us the information we need. Apparently this is sometimes not the case. Hopefully this audit with fix the problems in Tennessee and bring awareness nationwide.

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Carolyn Dickinson of Cottonwood Heights, Utah recently faced a problem that many Americans face today. She needed a nursing home for her mother and she needed to find one fast. Doctors told her that her mother, Carol, who had two strokes in the span of two weeks, needed to be put in a nursing home for a chance of survival. Eventually, after visiting several nursing homes Carolyn was able to find a suitable one.

Carolyn, like many others in the US today could have used some guidance when deciding on the right nursing home for her loved one. Listed below are some helpful tips from the federal government, state inspectors, and others for picking the correct nursing home. Also, listed below are tips for when you visit your loved one to make sure they are being treated with the utmost care.

Tips for picking a nursing home:

Location — People are more likely to visit a relative if the nursing home is close by.

First impressions — Make sure the home is clean, free from unpleasant odors and has good lighting.

Staff — Watch how the staff interacts with residents. Are they warm and respectful? Do they knock when they enter rooms?

Longevity — The best performing nursing homes usually have stable leadership that has been on the job for at least two years. How long have the administrator and director of nursing worked at the home?

The Room — Make sure your loved one will be in a comfortable space. Will he or she have a window? Access to a telephone? Their choice of roommates? Are the rooms clean? Do they have windows?

Food — Have a meal at the home to check on the quality of the food and make sure the staff takes care of those who need help eating. Does the home offer alternative meals daily?

Customer Satisfaction — Just about every nursing home does an annual survey. Ask to see the results. Be wary of homes that won’t turn them over.

Tips for visiting a relative:

Weight and Nutrition — Keep track of your relative’s weight to make sure it is not dropping rapidly. Ask the staff if your loved one is eating properly.

Bruises and Bedsores — Look for any unusual bruising or bedsores. Make sure they are recorded and treated properly.

Medications — A review of inspection reports shows that homes sometimes have problems monitoring insulin and other meds.

Living Space — Check the bedroom. Is it clean? Are the sheets dirty? Make sure the call light button and fresh water are within reach.

Staff — Resolve any complaints quickly but also don’t accept bad care.

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